Journal Article

Risk Factors for Falls in Older Men with HIV

THE BOTTOM LINE:

An ongoing study of men 50-75 years of age with HIV (279) or at risk for HIV (379) found that about 40% suffered one or more falls over a 2-year period. In both groups with two or more falls, illicit drug use, taking diabetes medications or depression medications, and peripheral neuropathy were the most frequent risk factors. In the subgroup with HIV in addition to the above factors (except depression medications), detectable plasma HIV RNA, and current use of efavirenz were related to serious falls. Longer duration of ART and greater physical activity were associated with lower risk of falls. Fall risk reduction strategies should consider increasing physical activity, better ART adherence, and if confirmed, possibly using ART other than efavirenz. 

ABSTRACT

BACKGROUND: Falls and fall risk factors are common among people living with HIV (PLWH). We sought to identify fall risk factors among men with and without HIV. METHODS: Men aged 50-75 years with (n = 279) and without HIV (n = 379) from the Bone Strength Substudy of the Multicenter AIDS Cohort Study were included. Multinomial logistic regression models identified risk factors associated with falling.

RESULTS: One hundred fourteen (41%) PLWH and 149 (39%) of uninfected men had >/=1 fall; 54 (20%) PLWH and 66 (17%) of uninfected men experienced >/=2 falls over 2 years. Five and 3% of PLWH and uninfected men, respectively, had a fall-related fracture (P = 0.34). In multivariate models, the odds of >/=2 falls were greater among men reporting illicit drug use, taking diabetes or depression medications, and with peripheral neuropathy; obesity was associated with a lower risk (all P < 0.05). In models restricted to PLWH, detectable plasma HIV-1 RNA, current use of efavirenz or diabetes medications, illicit drug use, and peripheral neuropathy were associated with greater odds of having >/=2 falls (P < 0.05). Current efavirenz use was associated with increased odds of an injurious fall; longer duration of antiretroviral therapy was protective (both P < 0.05). Greater physical activity was associated with lower risk of falls with fracture (P < 0.05).

CONCLUSIONS: Identified risk factors for recurrent falls or fall with fracture included low physical activity, detectable HIV-1 RNA, use of efavirenz, or use of medications to treat diabetes and depression. Fall risk reduction should prioritize interventions targeting modifiable risk factors including increased physical activity, antiretroviral therapy adherence, and transition off efavirenz.

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